Oncology surgeon Elizabeth Berger, MD, MS, FACS answers common questions about breast cancer recurrence.
This depends upon many things.
In general, triple-negative breast cancers and HER2-amplified breast cancers are
Also, more advanced breast cancers that have nodal involvement are more likely to recur than early stage breast cancers.
What are the chances that early breast cancer will come back?
If a woman’s initial cancer diagnosis is caught in an early stage, then it will be less likely to come back compared to a woman who has been diagnosed with a later stage breast cancer.
The chances of a recurrence are also dependent upon age. An older woman with an early stage hormone-receptor breast cancer who undergoes breast conservation plus radiation and anti-estrogen therapy will have a recurrence rate of about 2% in 10 years. This is very different than a young woman with advanced triple-negative breast cancer — their chance of recurrence is significantly higher.
This is dependent upon the type of breast cancer.
Typically, triple-negative and HER2-positive breast cancers are much more likely to return within 5 years of diagnosis, if they are going to return at all.
If a woman has a luminal A tumor, then it can recur many years later. For example, we sometimes see a recurrence of estrogen-sensitive breast cancers 10-plus years after initial diagnosis.
Also, the stage of breast cancer at the time of initial diagnosis can impact recurrence time. A locally advanced tumor is more likely to recur sooner than a less aggressive, smaller tumor.
When we think about recurrence risk, we consider many factors.
With regards to other cancer subtypes, the percentage of breast cancer survivors who get breast cancer again varies by:
- stage
- tumor subtype
- age
Young women with more aggressive tumors and more advanced stages (triple-negative breast cancer or HER2-positive breast cancers) have a much higher chance of recurrence.
However, in elderly women with very early stages of breast cancer, a very small percentage have a breast cancer recurrence — often less than 2% in 10 years.
Breast cancer doesn’t spread from one breast to another. But a woman diagnosed with breast cancer does have a 0.5% to 1% chance per year of developing a second cancer in the opposite breast, known as contralateral breast cancer.
Sometimes, there are many signs that breast cancer has returned. Other times, there are no signs at all.
A woman who treated her initial breast cancer with a lumpectomy may feel a palpable mass or lump, have nipple changes or bloody nipple discharge, or experience skin changes. This can be a sign that the breast cancer has returned.
If a woman has had a mastectomy, recurrence is often detected by feeling a mass or lump on the skin or chest wall. In some cases, a lump may be found in the armpit.
If breast cancer is coming back systemically (distantly), symptoms can vary based on where the cancer has returned. For instance, if it’s coming back in the bones, symptoms may include back pain or hip pain. If it’s coming back in the lungs, symptoms may include a cough or shortness of breath.
For a woman who had a lumpectomy, a recurrence is often detected on routine mammogram and ultrasound screening as either a new mass, calcifications, distortion, or asymmetry. This is often the most common sign that the cancer is back.
If a woman had a lumpectomy or mastectomy and feels an unusual lump, then usually a mammogram, ultrasound, and/or MRI is done to evaluate the palpable abnormality. If any skin changes are detected, a punch biopsy may be done to detect recurrence.
A distant recurrence can be detected with:
- CT scans
- PET scans
- MRIs
- bone scans
Most women treated for breast cancer have a very routine follow-up schedule, especially if they are taking an anti-estrogen pill or getting treatments after surgery.
Usually, a surgeon will schedule visits every 6 months for a few years after treatment.
Medical oncologists will often follow a patient for 5 to 10 years after surgery, especially if they are on therapy. Visits every 3, 6, and 12 months are very common for multiple years after treatment.
Call your doctor if you notice any changes to your mastectomy flap, such as:
- a “pimple,” nodule, or lump
- redness
- scaling of the skin
If you had a lumpectomy and your native breast is still intact, then call your doctor if you notice any of the following:
- palpable lump
- nipple discharge
- skin changes or dimpling
- lump in the armpit
These could all be signs of recurrence that should be examined by your doctor.
The obvious ways to lower the risk of recurrence is to complete the recommended treatment, which may include:
- surgery
- radiation
- chemotherapy
- hormone therapy
Following the recommended course of treatment will give you the best chance at preventing recurrence.
Other ways to decrease recurrence risk (which are all correlations) include:
- eating healthy
- limiting or avoiding alcohol
- quitting tobacco use
- staying fit
- reaching and maintaining a healthy weight
The thought of a breast cancer recurrence can be very challenging to deal with emotionally. There are often various resources that can help, including:
- support groups
- social work services at the hospital
- psycho-oncology services
- personal therapy
Leaning on family and friends for support during this time can also be very helpful.
Dr. Elizabeth Berger is an ABMS board certified assistant professor of surgery at Yale University School of Medicine in the division of surgical oncology. Dr. Berger was an American College of Surgeons (ACS) Clinical Scholar-in-Residence, and she was selected as the Breast Cancer Alliance fellow while at Memorial Sloan Kettering Cancer Center. Her research focuses on improving health outcomes for women with elderly breast cancer, including perioperative surgical quality, cancer care quality measure development, and assessment of surveillance strategies after breast cancer treatment.